Not yet ready to start a family? For a growing number of women, fertility treatment means giving their future selves the best odds to conceive when they are ready for this important life change.
“I want to start a family… just not right now.” As with any major change in life, starting a family is a big deal, so we do what we can to get the timing right. Is this something my partner and I both want? Can I afford to raise a child?
Unplanned pregnancies are one thing, but there are also pregnancies that are planned but never materialise. Sometimes a serious illness comes along and interferes with fertility. Sometimes it’s the natural decrease in fertility that comes with age.
We asked Dr Sulaiman Heylen, a specialist in reproductive medicine at a Cape Town fertility clinic, to share his views on the subject.
Why do you think more and more people are putting off having children until later in life?
We see that in first world countries the average age of the first baby is now 29. It has also been observed that some who are graduates have their first baby much later than women who did not study.
There is a perception that egg freezing is for ‘older’ women or unmarried women. In your opinion, who are the women who should be considering freezing their eggs?
Egg quality deteriorates quickly with age, it is best to do it before 35 and the ideal age is probably around 32. Unfortunately we see many women who are around 40 for egg freezing and that is much too late.
How common is egg freezing in South Africa?
It wasn’t all that common until recently. Now our practice alone does at least five cases per month and it is quickly increasing.
What do you wish more women knew about their fertility or their reproductive health?
Women should now that the amount of eggs in their bodies is limited. In an ideal world, every woman would have all her children before the age of 35, as the chance of conceiving decreases from the age of 35 and very fast from 38. This concept is called the ovarian reserve.
I always tell women that they must visualise that they are born with an egg basket. This basket is the total amount of eggs that they have and women lose 700 to 1 000 eggs every month by a process called atresia. This is then normal raging process of the ovaries.
What does the egg freezing procedure entail?
After the initial consultation, the next step is ovarian stimulation. Injections are usually started on the third day of a new menstrual cycle and must be taken for 10 to 12 days.
However, it is possible to start the ovarian stimulation at any time of the cycle – important in cases where cancer treatment may affect fertility but the patient needs to start chemotherapy ASAP. It is possible to inject yourself.
The doctor will do several ultrasound examinations to determine the best time to retrieve your eggs.
The egg retrieval is a small and painless operation under sedation with no hospitalisation needed. You can be discharged after two hours, and you will only need to take one day off work.
After your eggs have been retrieved, they are prepared in our laboratory by the embryologist who evaluates the appearance of the eggs and begins the process of preparing them for freezing by a rapid freezing technique called vitrification. This gives the highest success rates.
The eggs are then stored in the laboratory in a liquid nitrogen container at a temperature of -196 degrees Celsius.
Should you opt to use a frozen egg, what happens from there?
We thaw the eggs, fertilise with the sperm of husband/partner and transfer the fertilised egg, the embryo, back into the womb.
How long can eggs be stored?
Very long. There’s no significant time limit.
The decision of whether to have children or not is a very personal one, but also one that may change over time. Do you think it’s important to factor ‘just in case’ into our decisions?
Yes of course. But this is obviously that every woman must decide for herself.
How do you see the technology around preserving fertility advancing in years to come?
Freezing of ovarian tissue might become more successful. We might see more development in rejuvenating old eggs.
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